Dee Dee Wang et al. JIMG 2016;9:

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Dee Dee Wang et al. JIMG 2016;9:1349-1352 CT Guided Sizing of the Mitral Annulus Landing Zone and Fit-Testing CAD-Generated THV into Patient-Specific Mitral Anatomy to Predict LVOT Obstruction Pre-procedural imaging utilizes a contrast-enhanced, retrospectively electrocardiogram-gated computed tomography (CT) angiography acquisition without application of electrocardiogram-dose modulation (Table 1). Four-dimensional cine clips of the mitral annulus (MA) motion are generated. The MA plane is defined as the basal-most insertion of the mitral leaflets, characterized by a hinge-point motion of the leaflet base during the mid-to-late diastolic phase of the cardiac cycle, or in the case of a degenerative mitral ring/bioprosthesis, by prosthesis-artifact on CT. Using the double-oblique method, crosshairs are aligned to the MA plane in sagittal and coronal cross-sections (A and B) allowing for MA dimensions to be obtained on axial thin sections (C). Once the proposed THV size is identified, computer-aided design (CAD)-generated Sapien, Sapien XT (SXT) and Sapien 3 valves (Edwards Lifesciences, Irvine, California) are then virtually tested on-screen and again physically in the patient's 3DP anatomy to confirm sizing and estimate risk of LVOT obstruction (D). For difficult to-conceptualize computer-based 3D imaging anatomy, 3DP THV models were implanted into the 3DP patient-specific systolic left ventricular outflow tract (LVOT) model to help the structural heart team visualize the predicted LVOT obstruction to anatomical scale. HU = Hounsfield unit(s); TAVR = transcatheter aortic valve replacement; 3D = 3-dimensional; 3DP = 3-dimensionally printed; TMVR = transcatheter mitral valve replacement. Dee Dee Wang et al. JIMG 2016;9:1349-1352 American College of Cardiology Foundation